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AIM To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion. MATERIALS AND METHODS Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before-After (Pre-Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta-analysis. The certainty of evidence was assessed using the GRADE tool. RESULTS Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross-sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P

Background Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown. Objectives To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA-patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. Methods Fifty consecutive JIA patients (9-16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated. Results The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining "pain" (history of pain, TMJ pain, pain during movements) and "function" (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. Conclusion DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining "pain" and "function" findings for the evaluation of TMJ damage in JIA patients.

Objectives The aim of this study was to assess whether pain and strain of the periodontal ligament (PDL), induced by orthodontic separation, alter the somatosensory ability to perceive small thicknesses between occluding teeth (occlusal tactile acuity, OTA). Methods The OTA was tested at baseline (T0), using 9 aluminum foils (range 8–72 μm), randomly placed between the molar teeth, and 1 sham test (without foil), asking the participants whether they felt the foil between their teeth. Afterwards, orthodontic separators were placed, and subjects were randomly assigned to one of the two experimental groups: Group Pain (GP: 18 males; 14 females mean age 25.22 ± 2.28 years) had separators removed after 24 h; Group Strain (GS: 14 males; 17 females, mean age 24.03 ± 3.06 years) had separators removed after 7 days. The OTA measurement was repeated in both groups immediately after orthodontic separators removal (T1). A within-group comparison (T1 vs T0) was performed for each testing thickness (ANOVA for repeated measurements, with Bonferroni correction for multiple testing) (p < 0.005). Results GP showed statistically significant reduction of the OTA at T1, as compared to T0, for the thicknesses 24 μm (p = 0.004) and 32 μm (p = 0.001). No significant reduction was observed in GS (all p > 0.005). Conclusions Acute periodontal pain tends to disturb the tactile ability of the teeth, while strain of the PDL in absence of painful sensation determines a return to OTA baseline values. Clinical relevance The reduction of OTA might explain the uncomfortable occlusal sensation referred by patients during acute periodontal pain.

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases.

This study aimed to evaluate the periodontal health of orthodontic patients with supportive periodontal therapy in a 3 month follow-up. The sample comprised 20 patients (mean age 20.6 &plusmn, 8.1 years) in treatment with multibracket fixed appliances (fixed group&mdash, FG) and 20 patients (mean age 34.7 &plusmn, 12.5 years) in treatment with clear aligners (clear aligners group&mdash, CAG). At baseline (T0) and after 3 months (T1), probing depth (PD), plaque index (PI), bleeding on probing (BOP), and gingival recession (REC) were measured. Patients were trained to perform an individualized tooth brushing technique, and every 2 weeks they were re-called to reinforce the oral hygiene instructions. The intra-group comparisons (T1 vs. T0) were calculated with the Wilcoxon signed-rank test, while a linear regression model was used for the inter-group comparisons (FG vs. CAG). The significance level was set at p &lt, 0.05. Statistically significant decrease in both groups was found for PD (FG: &Delta, &minus, 9.2 inter-quartile range (IQR), &minus, 22.5, &minus, 5.5, CAG: &Delta, 12.6 IQR, &minus, 25.4, &minus, 4.8), BOP (FG: &Delta, 53.5 IQR, &minus, 70.5, &minus, 37, 37.5 IQR, &minus, 54.5, &minus, 23), and PI (FG: &Delta, 17.5 IQR, &minus, 62.5, 14.5, 24 IQR, &minus, 49.5, &minus, 5). The result of the linear regression models suggested that the type of appliance did not have any effects on the improvement of periodontal variables. Therefore, patients undergoing orthodontic treatment with fixed appliances and clear aligners did not show differences in gingival health when followed by a dental hygienist.

Background The prevalence of malocclusion, temporomandibular disorders (TMD) and oral parafunctions is highly debated in children population. Objectives To investigate the prevalence of malocclusion, self-reported oral parafunctions and TMD-pain in Italian schoolchildren and to assess the association between the examined factors. Methods A total of 700 children aged 9-11 years were selected among six public schools in Campania region (Italy). Molar relationship, overjet, overbite and cross-bite were assessed through a clinical examination. Furthermore, the subjects were demanded to fill in a validated questionnaire for TMD-pain screening and the short form of the Oral Behaviours Checklist. Descriptive statistics were used to report the frequencies. The associations between occlusal traits, oral parafunctions and TMD-pain were analysed with a Pearson chi-square test, as expressed by odds ratio and 95% confidence intervals. The significance level was set at P < 0.05. Results Molar Class I was the most frequently encountered molar relationship, followed by molar Class II, subdivision and molar Class III. Increased overjet was more common than negative overjet. Posterior cross-bite was observed in 12% of children. TMD-pain was recorded in 14.7% of subjects. High frequency of oral parafunctions was reported in 21.3% of subjects. A significant association was found between TMD-pain and negative overbite. Cross-bite and high frequency of oral parafunctions were associated with TMD-pain. Conclusion The current results show that malocclusion, self-reported oral parafunctions and TMD-pain are frequent findings among Italian schoolchildren and that some occlusal factors and high frequency of oral parafunctions might be associated with TMD-pain.

Objective: To investigate the cytotoxicity of nickel-titanium (NiTi) esthetic orthodontic archwires with different surface coatings. Materials and Methods: Three fully coated, tooth-colored NiTi wires (BioCosmetic, Titanol Cosmetic, EverWhite), two ion-implanted wires (TMA Purple, Sentalloy High Aesthetic), five uncoated NiTi wires (BioStarter, BioTorque, Titanol Superelastic, Memory Wire Superelastic, and Sentalloy), one β-titanium wire (TMA), and one stainless steel wire (Stainless Steel) were considered for this study. The wire samples were placed at 37°C in airtight test tubes containing Dulbecco’s Modified Eagle’s Medium (0.1 mg/mL) for 1, 7, 14, and 30 days. The cell viability of human gingival fibroblasts (HGFs) cultured with this medium was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Data were analyzed by a two-way analysis of variance (α = .05). Results: The highest cytotoxic effect was reached on day 30 for all samples. The archwires exhibited a cytotoxicity on HGFs ranging from “none” to “slight,” with the exception of the BioTorque, which resulted in moderate cytotoxicity on day 30. Significant differences were found between esthetic archwires and their uncoated pairs only for BioCosmetic (P = .001) and EverWhite (P < .001). Conclusions: Under the experimental conditions, all of the NiTi esthetic archwires resulted in slight cytotoxicity, as did the respective uncoated wires. For this reason their clinical use may be considered to have similar risks to the uncoated archwires.

This Systematic Review (SR) aims to assess the quality of SRs and Meta-Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel-2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2-10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues.

To summarise the skeletal, dental and soft tissue effects of orthopaedic treatment on growing skeletal class III patients compared with a concurrent untreated similar control group and to evaluate whether the design of the primary studies may affect the results. A literature search was performed up to the end of February 2016. No restrictions were applied concerning language and appliances. Once the quality score was assessed, a meta-analysis was performed for the appliances used in more than three studies. A moderator analysis for study design was performed. The level of evidence was evaluated by means of the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. The search resulted in 21 papers. The quality of most of the studies was medium. Each study reported skeletal sagittal improvement and overjet correction. Fourteen studies reported a significant increase in lower facial height. Follow-up data showed slight relapses in about 15% of patients. Meta-analyses were performed for the facemask and chin cup. The two appliances were efficient for correcting the sagittal discrepancy, increasing the divergence. In the analysis for study design, the retrospective studies showed a more efficient appliance than RCTs for 6 of 13 variables. The level of evidence was between very low and moderate. There is very low to low evidence that orthopaedic treatment is effective in the correction of Class III skeletal discrepancies and moderate evidence for the correction of the overjet. A common side effect is mandibular clockwise rotation in older subjects.

The aim was to assess the quality and to summarise the findings of the Systematic Reviews (SRs) and Meta-Analyses (MAs) on the dental and skeletal effects of maxillary expansion. Electronic and manual searches have been independently conducted by two investigators, up to February 2015. SRs and MAs on the dentoalveolar and skeletal effects of fixed expanders were included. The methodological quality was assessed using the AMSTAR (A Measurement Tool to Assess Systematic Reviews). The design of the primary studies included in each SR/MA was assessed with the LRD (Level of Research Design scoring). The evidence for each outcome was rated applying a pre-determined scale. Twelve SRs/MAs were included. The AMSTAR scores ranged from 4 to 10. Two SRs/MAs included only RCTs. The current findings from SRs/MAs support with high evidence a significant increase in the short-term of maxillary dentoalveolar transversal dimensions after Rapid Maxillary Expansion (RME). The same effect is reported with moderate evidence after Slow Maxillary Expansion (SME). However, there is moderate evidence of a non-significant difference between the two expansion modalities concerning the short-term dentoalveolar effects. With both RME and SME, significant increase of skeletal transversal dimension in the short-term is reported, and the skeletal expansion is always smaller than the dentoalveolar. Even though dental relapse to some extent is present, long-term results of the dentoalveolar effects show an increase of the transversal dimension, supported by moderate evidence for RME and low evidence for SME. Skeletal long-term effects are reported only with RME, supported by very low evidence.

Objective: To assess interobserver and intraobserver reproducibility of the cervical vertebrae maturation method (CVMM) among three panels of judges with different levels of orthodontic experience (OE). Materials and Methods: Fifty individual lateral cephalograms of good quality with complete visualization of cervical vertebrae 1 to 4 were selected. Thirty clinicians, divided according to their OE into three groups (junior group, JU, OE ≤ 1 year; postgraduate group, PG, 2 ≤ OE ≤ 4 years; specialist group, SP, OE ≥ 7 years), evaluated the cephalograms in two sessions (T1 and T2) at 3 weeks apart. Kendall's W and weighted Cohen's kappa (κ) coefficients were performed to assess interobserver and intraobserver agreement. The level of significance was set as P < .05. For both the interobserver and the intraobserver datasets, the percentage of perfect agreement (PPA) and the number of stages apart for each disagreement were calculated. Results: Kendall's W at T1 was SP = 0.61, PG = 0.70, and JU = 0.87; at T2 it was SP = 0.78, PG = 0.85, and JU = 0.86. The percentage of total interobserver perfect agreement (Inter-PPA) was 42.3% at T1 and 46.3% at T2. The JU group had the highest Cohen's κ coefficient at 0.78, while the PG and SP had coefficients of 0.64 each. The percentage of total intraobserver perfect agreement (Intra-PPA) was 54.2%. Conclusions: The reproducibility of the method was not improved by the level of orthodontic experience. The group with the lowest level of orthodontic experience had the best performance.